Reduce the spread of HIV harm associated with drug use amongst men and women in the Lao PDR: -HAARP Country Flexible Program Lao PDR (LAO/K18)
The HIV/AIDS Asia Regional Program (HAARP) - Country Flexible Program (CFP) for Lao PDR will contribute to the National Strategy and Action Plan on HIV/AIDS/STIs and the National Drug Control Masterplan, to ultimately reduce the harms associated with drug use and thus preventing the rise of HIV in the Lao PDR. By supporting a multi-sectoral approach lead by UNODC to harmonise the response of relevant stakeholders, the HAARP program aims to effectively introduce a comprehensive harm reduction service for the three main groups of drug users, including opium, yaba and heroin users.
Injecting Drug Use (IDU)
There is some evidence of the emergence of IDU in some communities in border areas. However, there is no systematic collection of data relating to IDU and most reports are derived from sources such as police records and other community surveys. Currently, IDU appears to be fairly isolated and in small numbers but evidence suggests that the practice of injecting is on the increase. The injecting of heroin has been observed in border areas and cities since 2004. In a study carried out by Lao National Commission for Drug Control and Supervision (LCDC), Centre for HIV and AIDS (CHAS), UNODC and Burnet Institute, IDU was reported in all border towns adjacent to the assessment sites of Lak Sao, Phongsali and Luang Namtha. In addition, the 2008 UNGASS country report also indicates that IDU is increasing in Lao PDR. At present, IDU is confined to small numbers of young heroin users and the switch from non-injecting to injecting has been largely attributed to the cost, purity and efficiency of administration. For older opium users, the transition is due to the increasing cost and scarcity of opium and the lack of effective treatment for opium dependence. An LCDC and UNODC IDU assessment carried out in 35 villages in three border areas indicated that 2.8% of the population 15 years old and above were using heroin and 4% of heroin users were injecting.
HIV and AIDS
The Lao PDR is a low HIV prevalence country surrounded by countries with higher HIV prevalence and concentrated epidemics. The overall adult HIV prevalence rate (aged 15 to 49) has been estimated by UNAIDS in 2007 to be 0.2% However higher prevalence rates have been shown among sex workers in urban sites (1.1-3.3%) and MSM in Vientiane (5.6%). Systematic HIV surveillance among drug users is lacking. A small proportion (less than 5%) of HIV cases were found among IDUs, however it is unclear the extent to which MSM or sex workers may also be injecting drugs.
A multi-sectoral Task Force on drug use and HIV, co-chaired by the Ministry of Health (MoH) and LCDC, was formed in November 2007. The Task Force is currently being supported by UNODC and WHO under the Swedish International Development Agency (SIDA) funded HR3 project, and will be constituted as the project management unit of the LAO-K18 project. The Task Force is comprised of 10 permanent members (5 from MoH, 5 from LCDC) and 3 ex-officio members (1 UNODC, 1 WHO, 1 UNAIDS) as resource persons. They will meet at least 6 times a year and have the responsibility of developing a policy on drug use and HIV, proposing concrete measures to reduce vulnerability of drug users, finding ways of address drug addiction in the Lao PDR, and review and update existing treatment protocols.
Cross Cutting Issues
A number of cross cutting issues will have an impact on the performance of HAARP Lao PDR and will, where appropriate, be addressed or integrated into the program of work. HAARP Lao PDR will ensure that considerations of gender are undertaken and effectively integrated into the program of work. Implementing partners will be required to address gender issues in the framing of work plans and budgets. Particular challenges in accessing 'hidden' populations such as IDUs, SWs and migratory populations, particularly those involved in cross border trade and employment, require the tailoring of IEC and outreach services to accommodate women's specific needs. Improving access to services including prevention, harm reduction and treatment, will need to incorporate a gender perspective to ensure that the different needs of men and women in accessing services are fully considered and addressed. All training curriculum developed under the program will need to take into consideration gender needs.
Another key theme of HAARP Lao PDR will be the participation of local organizations and drug users and their families in key decision-making and work planning processes. One of the long-term aims of HAARP Lao PDR will be to support the formation of networks and other communication channels that can provide a user's perspective in the program's decision-making processes. Support will be provided through local organizations to develop a beneficiary representative body that could potentially, over the life of the program, be integrated as a member of the HAARP Steering Committee.